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27 Cards in this Set
- Front
- Back
- 3rd side (hint)
Top 3A4 inducers |
CS PROPS
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carbamazepine
smoking phenytoin rifampin oxcarbazepine phenobarbital st johns wort |
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Top 3A4 inhibitors
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GI PAC MAN:
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grape fruit
inh protease inhibitors azole cimetidine macrolides ( not azith) amiodarone non-DHP's |
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amiodarone significant interactions
(inhibitors and substrates) |
inhibitor of:
2C9 2D6 3A4 P-gp |
Substrate of:
3A4 2C8 |
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amiodarone significant interactions continued (lower does of the following)
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digoxin (increase QT prolongation)
warfarin (increase bleeding) quinidine (increase QT prolongation) procainamide (increase QT prolongation) simvastation (increase myalgia risk) lovastatin (increase myalgia risk) atorvastin (increase myalgia risk) |
amiodarone has a grapefruit interaction
because amidarone is a not only a substrate but also a 3A4 inhibitor |
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Azole interactions
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intraconazole pH dependent for absorption.
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Give with food to increase absorption and avoid H2 blockers, PPIs, antacids
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clopidogrel interactions
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avoid:
2C19 inhibitors esomeprazole omeprazole |
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colchine interactions (dont use)
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in renal or hepatic patients
3A4 inhibitors P-gp inhibitors |
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Digoxin interactions
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concerned with renal and hepatic clearance (because cleared by kidneys and partially metabolized by liver)
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Digoxin levels increased with:
PAC MANS propafenone amiodarone macrolides azoles non-DHPs Spironolactone |
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Lamotrigine and valproate interactions
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increase risk of severe rash
titrate slowly |
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lithium interactions
(increase levels and decrease levels) |
decreased salt
dehydration (diuretics) NSAIDS ACE I's/ ARBS |
increase salt
caffeine theophylline |
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Lithium contiuned
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increased risk of 5HT syndrome with:
SSRI, SNRIS, triptans, linezolid |
increase risk of neurotoxicity:
non-DHPS phenytoin carbamazepine |
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MAO inhibitor interactions increae of ?
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serotonin syndrome with:
Antidepressants SSRIs, SNRIs, TCA, tramadolm, triptans, st johns wort etc. |
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NSAIDs can:
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raise blood pressure and have cardiovascular toxicity (M.I.) except ASA
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birth control interactions
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ABX, anticonvulsants, st johns wort, protease inhibitors, nevirapoine
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Smoking increase of stroke, MI
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OPIODS
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substrate of 3A4
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Rifampin interactions
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warfarin (decreases INR)
birth control 2C9, 2C19, 3A4 substrates (rifampin inducer) |
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Statin interactions
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Telithromycin with lovastitin, simvastatin, atorvastatin, may increase risk of muscle damage therefore hold these meds
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dont use pitivastatin with cyclosporine
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tamoxifen interactions
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interaction with 2D6 inhibitors, (SSRIs)
because prevents conversion of active form of tamoxifen |
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tetracyline and FQ inteactions
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Chelating drugs/foods:
antacids, Mg, Al, Zn, Ca2+, Fe, sucralfatem buffered aspirin (space at least 2 before and 2 after) |
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theophylline interactions
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it follows First order kinetics followed by Zero order ( like phenytion, voriconizole).
metabolized by 3A4 and 1A2 therefore interacts with: BC, GI PAC MAN, CS PROPS, |
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Warfarin interactions
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S-isomer 3 to 5 times stronger than R.
2C9 substrate |
2C9 inducers: P.R.'s
phenobarbital phenytoin primidone rifampin St Johns wort 2C9 inhibitors: amiodarone Bactrim Azoles Tamoxifen (C/I) metronidazole |
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Warfarin Pharmacodynamics
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NSAIDS (not selective agents), ASA, Plavix,, DEFFGGGG (Dong Quai, vitamin E, fever few, fish oil, ginko, ginger, garlic, ginseng, ST johns wort, SSRIs,
INCREASES BLEEDING RISK BUT NOT INR |
Warfarin and ASA unnecessary in STENT PATIENTS there dont pick in NAPLEX pick PLAVIX and ASA
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Hyperkalemia RISK
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ACE I's, ARB's, sparing diuretics, YAZ. YASMIN, NATAZIA
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CNS DEPRESSION
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OH, PN meds, mirtazipine, trazodone, proprandolol, clonidine
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QT prolongation
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Time it take the heart to re-polarize after each beat. may lead to torsafe de pointes
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CLASS 1 and 3 antiarrhythmics (amidarone, disopyramide, procainamide, qunidine, sotalol), FQ, Macorlides, Azoles, TCA's, Antipsychotics, methadone,
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narrow therapeutic drugs
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Carbamazepine, Levothyroxine, lithium, phenytion, theophylline, digoxin, procainamde, Valproic acid, warfarin
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2C9 inhibs
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FAMIS
fluconazole amiodarone metronidazole INH sulfamethoxazole/TMP |
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